本文關(guān)鍵詞： 毒邪 重癥心力衰竭 發(fā)病機(jī)制 解毒法 肌酐 總膽紅素 高敏C反應(yīng)蛋白　出處：《南京中醫(yī)藥大學(xué)》2017年博士論文　論文類型：學(xué)位論文

【摘要】：目的重癥心力衰竭是最嚴(yán)重的心血管疾病之一。近年來,雖然中西醫(yī)學(xué)對其發(fā)病機(jī)制的認(rèn)識(shí)逐漸深入,治療理念、方法和藥物不斷進(jìn)步,臨床療效亦有所提高,但是該病的再住院率及死亡率仍居高不下。本研究擬通過中醫(yī)理論研究,明確提出"毒"邪在重癥心力衰竭中的發(fā)病機(jī)制,提出解毒法是其基本治療大法之一。通過臨床研究證實(shí)"毒"邪是重癥心力衰竭的重要發(fā)病機(jī)制,探究解毒法祛除重癥心力衰竭"毒"邪的重要價(jià)值,為提高重癥心力衰竭患者的臨床療效水平,深化相關(guān)研究提供有益的思路與參考。方法依據(jù)重癥心力衰竭現(xiàn)代醫(yī)學(xué)及中醫(yī)學(xué)研究的既往資料,從中醫(yī)理論上明確提出并論述了"毒"邪在重癥心力衰竭中的發(fā)病機(jī)制,詳述了毒邪與瘀水互因互生的關(guān)系。提出解毒法是其基本治療大法之一。指出了利水解毒法、扶正解毒法、活血解毒法、利濕解毒法、清熱解毒法、涼血解毒法、通便解毒法等7種解毒法。選取重癥心力衰竭陽虛血瘀水停毒聚患者,對照組治療采用基礎(chǔ)西藥治療(對照組),常規(guī)中藥組在對照組基礎(chǔ)上配合中藥常規(guī)溫陽活血利水法治療,解毒組在常規(guī)中藥組治法基礎(chǔ)上配合解毒法。觀察治療前后有關(guān)臨床和理化指標(biāo)(癥狀積分療效、入院到達(dá)干體重的天數(shù)、心功能分級(jí)變化、生活質(zhì)量評(píng)估、6分鐘步行試驗(yàn)、左室射血分?jǐn)?shù)(LVEF)、血肌酐和尿素氮、血谷丙轉(zhuǎn)氨酶和總膽紅素(TBIL)、血高敏C反應(yīng)蛋白(hs-CRP)和B型利鈉肽(BNP)、尿α 1微球蛋白和微量白蛋白的變化。結(jié)果重癥心力衰竭患者解毒組和常規(guī)中藥療法治療后比較,癥狀積分療效(顯效率66.7:53.3,%)、心功能分級(jí)療效(顯效率63.3:56.7,%)、6分鐘步行距離(434.9::393.1,m)、BNP 水平(621.2:710.2,pg/ml)、LVEF(47.8:46.8,%)、血尿素氮(7.8:8.4,mmol/L)以及尿α 1MG(12.2:14.6,mg/L),均有一定改善,但尚未達(dá)到統(tǒng)計(jì)學(xué)差異。重癥心力衰竭患者解毒組和常規(guī)中藥療法比較,明尼蘇達(dá)心力衰竭生活質(zhì)量評(píng)分(積分35.1:40.3)、達(dá)干體重患者的平均天數(shù)(6.46:7.38,天)、血肌酐(72.1:81.7,umol/L)、血TBIL(11.7:14.2,mmol/L)、hs-CRP(6.5:8.l,mg/L)、尿 mALB(12.1:15.2,mg/L)等結(jié)果均有顯著差異(P0.05)。重癥心力衰竭患者解毒組和對照組比較,以上各項(xiàng)觀察指標(biāo)均有不同程度差異(P0.05 或 P0.01)。臨床研究結(jié)果提示解毒法能進(jìn)一步改善重癥心力衰竭患者的臨床療效、縮短達(dá)干體重療程、降低BNP水平,促進(jìn)心功能恢復(fù)、降低重癥心力衰竭患者的腎毒(肌酐和尿素氮)水平、炎毒反應(yīng)水平、保護(hù)肝腎功能、降低肝毒(TBIL)水平、防治早期腎損害等作用。結(jié)論"毒"邪是重癥心力衰竭發(fā)病的重要機(jī)制,解毒法是治療重癥心力衰竭的有效措施。解毒法的實(shí)質(zhì)是"減毒"、"消毒"和"排毒"。該法具有協(xié)同增強(qiáng)心肌收縮力、降低利尿鈉肽水平、抗炎"毒"反應(yīng)、清除腎毒(肌酐和尿素氮)、保肝清毒(如總膽紅素)、保護(hù)腎小球和腎小管等作用,該法對重癥心力衰竭治療作用可能與拮抗交感神經(jīng)系統(tǒng)活性和拮抗RAAS有關(guān)。
[Abstract]:The purpose of severe heart failure is one of the most serious cardiovascular disease. In recent years, although the Chinese and Western medicine understanding of its pathogenesis gradually, treatment concept, methods and progress of clinical medicine, also increased, but the disease hospitalization rate and mortality rate is still high. This study proposed by the theory of traditional Chinese medicine research, clear put forward the "pathogenesis of toxic evil in severe heart failure, the detoxification is the basic treatment of. Through clinical research confirmed that the poison is an important pathogenesis of severe heart failure, an important value of detoxification removing poison in severe heart failure, in order to improve the level of clinical efficacy in patients with severe heart failure, providing ideas and reference to deepen the related research. Research methods based on severe heart failure in modern medicine and traditional Chinese medicine in the past data, from the TCM theory and put forward clearly Discusses the pathogenesis of toxic evil in severe heart failure in detail, pathogenic toxin and stasis water due to alternate relationship. Proposed detoxification is the basic treatment of law. It is pointed out that the water detoxification method, removing toxin, blood detoxification method, dampness detoxification, detoxification, detoxification method. 7 laxative detoxification detoxification method. Selected patients with severe heart failure Yang deficiency and blood stasis of water stop drug accumulation patients, control group treated by Western Medicine (control group), conventional Chinese medicine group on the basis of the control group with routine Chinese herbal medicine Wenyang Huoxue Lishui treatment group with detoxification detoxification method in the conventional treatment based on traditional Chinese medicine group. Observed before and after treatment of clinical and physiochemical indexes (symptom efficacy, hospitalization days to dry weight, heart function change, quality of life assessment, the 6 minute walk test, left ventricular ejection fraction (LVEF), serum creatinine and blood urea nitrogen, serum alanine. Aspartate aminotransferase and total bilirubin (TBIL), serum high-sensitivity C reactive protein (hs-CRP) and B type natriuretic peptide (BNP), the changes of urinary albumin and alpha 1 microglobulin. Results the detoxification group and conventional medicine therapy in patients with severe heart failure after treatment, symptom efficacy (the effective rate was 66.7: 53.3,%), heart function classification effect (the effective rate was 63.3:56.7,%), 6 minutes walking distance (434.9:: 393.1, m), BNP (621.2:710.2, pg/ml), LVEF (47.8:46.8,%), blood urea nitrogen (7.8:8.4, mmol/L) and urine 1MG (12.2:14.6, mg/L) alpha, have certain improvement, but there were no significant differences between groups comparison of patients with severe heart failure. Detoxification group and conventional medicine therapy, quality of life score (Minnesota heart failure score 35.1:40.3), the average number of days up to dry weight patients (6.46:7.38 days), serum creatinine (72.1:81.7, umol/L), blood TBIL (11.7:14.2, mmol/L), hs-CRP (6.5:8.l, mg/L), urine mALB (12.1:15.2, mg/ L) were significant difference (P0.05) in patients with severe heart failure. Detoxification group and control group, the above indexes have different degrees of difference (P0.05 or P0.01). The clinical results suggest that detoxification method can further improve clinical efficacy in patients with severe heart failure, shorten the course of dry weight, decrease the level of BNP, improve heart function recovery, reduce renal toxicity in patients with severe heart failure (creatinine and urea) level, inflammatory toxicity level, protect liver and kidney function, reduce liver toxicity (TBIL) level of prevention and treatment effects of early renal damage. Conclusion poison is an important mechanism in the pathogenesis of severe heart failure, detoxification method is an effective approach for treatment of severe heart failure. The essence of detoxification is "attenuated", "sterilization" and "Detox". This method has enhanced myocardial contractility, reduce natriuretic peptide levels, inflammatory reaction, removal of the "poison" of renal toxicity (creatinine and urea nitrogen), Paul Liver clearing toxin (such as total bilirubin) protects glomeruli and renal tubules, which may play a role in antagonizing sympathetic nervous system activity and antagonizing RAAS.

【學(xué)位授予單位】：南京中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2017
【分類號(hào)】：R259

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